Where Is the Cure for the Migraine?

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CreditJooHee Yoon

By Michele Willens

Dec. 12, 2015

AT least 36 million Americans suffer from migraines, and while more and more medical professionals are on the case, they have never found satisfactory answers for why the pain starts, let alone how to make it end.

Lately, it seems I can’t attend a gathering of friends without at least one complaining about headaches, and another offering advice: It’s your glasses, your diet or, the old standby, your stress level. Regarding the latter, let me say that a friend and I once spent four days at a spa, doing nothing but exercise classes and beauty treatments, and we were still popping pills for our pounding heads nonstop.

Over the last few decades, migraines (intensely painful headaches that make it difficult to function and are often accompanied by other symptoms like vomiting) have become big business. Billions of dollars are spent annually on over-the-counter and prescription remedies, as well as visits to the increasing number of specialized clinics and hospital departments around the country. Even dermatologists, dentists and non-Western holistic practitioners are getting in on the action.

For every sufferer, there is an anecdote about a temporary fix. Botox has become a godsend for some, though an injection — make that 31 tiny injections — must be repeated every 12 weeks. For others, simply putting ice on the back of the neck, or wherever the pain is, works. (It seems to reduce inflammation.)

The most effective drugs so far arrived in the early 1990s. These medications, known as triptans, include Imitrex, my current drug of choice. While they have brought temporary relief, they have not prevented or reduced the overall number of headaches.

Now we may have true cause for hope.

At least four large companies are holding clinical trials to study something called monoclonal antibody therapy. This therapy uses genetically engineered antibodies to stimulate the immune system and attack a nasty compound that is elevated in the brain during migraine headache pain. The treatment would be injected periodically. It has had excellent results in early trials, and could be available within a few years. “Not only is this the most hopeful thing on the horizon,” said Dr. Joseph Safdieh, a neurologist at Weill Cornell Medical College who is not involved with the trials, “it is the only hope on the horizon.”

But why has it taken so long to find a fix for an ailment that so many millions suffer from? The answer may be that what looks like one syndrome could actually be a symptom of a number of different conditions.

According to Dr. Steven B. Graff-Radford, the director of the Headache and Orofacial Pain Program at Cedars-Sinai Medical Center in Los Angeles, “most migraine sufferers are undiagnosed or given the wrong diagnosis.” He said, “They go to their general doctor — when they should be seen by specialists — and are told they have sinus or tension headaches, which are treated with antibiotics or psychological management, when they have other kinds that should be treated another way.”

There are countless possible causes of headaches. “I find, almost as soon as I am recognizing the trigger in my midst — an artificial scent or bright light or barometric pressure — it’s too late and I have to ride the wave,” Cara Levine, an artist in Northern California, told me last year. Crippling, psychedelic migraines like Ms. Levine’s are often hereditary, and she recently discovered that her grandmother also apparently suffered from them.

No demographic is immune. Boomers may seem to kvetch the most about them. But Dr. Safdieh said that “about 5 percent of children (boys and girls equally) are afflicted, and the demographic most diagnosed with migraines is young women.”

“Mine started at a very early age, about 5,” said Gay Abrams of Los Angeles. “When I was a child, I spent many long nights lying on a cold bathroom floor.” Sometimes, she said, “I would keep a pail near my bed.”

Zoey Kolligian, a 17-year-old in Princeton, N.J., missed almost all of the ninth and 10th grades because of blinding migraines. She was eventually told she had Lyme disease and, with appropriate treatment, the headaches subsided. In a class paper, Zoey described the ordeal. “There is no pain I have ever known that compares,” she wrote. “Auras were the harbingers of stress, school absences, pain. They stole my life as I knew it.”

For some, migraines coincide with hormonal fluctuations. Serena Williams says she has lost matches because of “menstrual migraines.” Ruth Reichl, the food writer, had a headache every day of her life from adolescence until she became pregnant in her 40s. “Nine months of bliss,” she said. “Then Nick arrived, and the headaches came back.”

This is yet another conundrum. “The common occurrence of headache at the time of menses, improvement during pregnancy for some but not all women, and worsening during early menopause, suggest hormonal links,” said Dr. Morris Levin, director of the UCSF Headache Center. “It is curious, and shows we have much to learn.”

Lest you think this is just a girl thing (“Not tonight dear…”), know that about a quarter of migraine sufferers are male. Perry Simon, a television executive, mistakenly thought for years that his headaches were sinus-related. During a particularly pain-fraught two-year period, “they were strong enough to seriously disrupt and limit my lifestyle,” he said. He finally found relief in bi-weekly sessions with an acupuncturist. The tips he was given included getting plenty of sleep and minimizing caffeine intake. But, he said, “his most important message was making me understand I was in a downward spiral and the key was to reverse it.”

My own headaches began in my 50s, and while they are not debilitating, they are always — pardon the expression — on my mind. For now, I cling to the promise of this hopeful new treatment. In that, I am not alone. “I can’t wait till they find the answer,” Mr. Simon told me, “so that I can start focusing on my aching back.”

Michele Willens is a freelance writer and podcaster for NPR’s Robinhoodradio.